July 13, 2023/Mental Health

Intrusive Thoughts Are All in Your Head

When unwanted and alarming thoughts, images or urges take hold, you can lessen their grip

person standing in front of mirror seeing smaller version of self

You ever think about something that just seems to come out of left field and catch you by surprise?


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Maybe while having a conversation with a particularly annoying coworker, you envision slapping them or pushing them off a cliff. Or on your way home, you imagine what would happen if you just let your car veer off the road and into oncoming traffic. And then there are all those times you think of something so horrific happening to your own children that you get anxious and afraid for their well-being even when there’s no real sense of impending doom.

No matter how hard you try to shut these thoughts or images down, they continue to come back and alarm you. Of course you would never do any of these things that pop into your head … right? And thinking of them doesn’t make them a reality. So, why are these intrusive thoughts happening, and what does it mean that you’re having them even when you really don’t want to buy into them?

Psychologist Lauren Alexander, PhD, breaks down the meaning behind the intrusive thoughts you’re having, along with tips for stopping intrusive thoughts in their tracks.

What are intrusive thoughts?

Intrusive thoughts are thoughts, images or urges that are unwanted but pop into your mind anyway. They find a way of disrupting your original thought patterns and can come out of nowhere or they can be cued by external stimuli (like in response to a situation or event) or internal stimuli (like anxiety, depression or other feelings). Intrusive thoughts are often violent, disturbing or unnerving in nature.

Let’s say you show up to a social gathering with your friends after being away from them for a few months. You’re a little anxious because you’ve been out of the loop for awhile, but of course, everyone there knows and loves you. And yet, as you’re getting ready to arrive, you start to think, What if no one talks to me? What if I’m not wanted? What would I do if I show up and we’re not as close as we used to be?

Suddenly, you’re caught in a loop of unwanted negative self-talk and a barrage of intrusive thoughts that you’re undesirable, despite knowing at your core that you’re loved, supported and accepted. And the more you try to fight off the intrusive thoughts or switch to something else, the more the thoughts come back in full force.

“A lot of times, people believe that if they have the thought, it’s true. And particularly, if they keep thinking it over and over again, then that especially means that it’s true,” explains Dr. Alexander. “But just because you have the thought doesn’t mean that it’s true. Unless it’s acted on, it doesn’t really have a whole lot of bearing on reality.”

What causes intrusive thoughts?

“Sometimes, thoughts can be just completely random, and you go, Wow, where did that come from?” says Dr. Alexander. “But a lot of times, intrusive thoughts are related to something that you’re already anxious about.”

Anxiety disorders, and even low-boiling anxieties, have a way of complicating the way you interact with the world around you and your ability to regulate your emotions.

“Anxiety is a very sticky emotion,” notes Dr. Alexander. “If you’re anxious about one thing, it’s easy to get anxious about other things. And if you’ve got any variety of stressors in your life, I think that makes you a little more prone to getting stuck on intrusive thoughts.”

Intrusive thoughts are also commonly associated with other mental health conditions, like:

Research has also shown that lack of sleep leads to an increase in intrusive thoughts, likely because of your brain’s inability to rationalize, focus and stay on task.


“The more mental health issues you pile on, the harder it’s going to be to manage intrusive thoughts,” says Dr. Alexander. “Sometimes, intrusive thoughts can turn into something more.”

For someone who has PTSD, intrusive thoughts can appear like flashbacks or blips of thought or images that call back to an experienced trauma.

For someone who has OCD, they may have continuing intrusive thoughts that pile up about a number of things, like the cleanliness of a room, how things look in their workspace and keeping up their appearance in a very specific way. Over time, if left untreated and acted upon, those intrusive thoughts can develop into obsessions.

“You can think of your mental health or your emotional resources as having a finite amount, just like we all have a finite amount of money,” clarifies Dr. Alexander. “Emotional resources are the same way.”

Types of intrusive thoughts

Intrusive thoughts are easy to identify: If they pop up over and over again, especially if you don’t want them to, they’re intrusive. These thoughts can appear as:

  • Highly specific thoughts: These thoughts can come at random or as a response to a specific situation. For example, if your child falls and breaks a tooth, you might have persistent intrusive thoughts about them getting a serious infection. If you have a fear of losing your job, you might experience thoughts of losing your home or homelessness. If your parent is ill, you might think persistently about the worst-case scenario of them dying.
  • Images: You might visualize scenes or images play out in your mind in response to what’s happening around you or out of the blue. If someone cuts you off on the highway, in response to anger, you might have lingering intrusive thoughts about running them off the road. And if you have anxiety about climate change, you might consistently picture what would happen if you were to experience a flood, tornado or other natural disaster and how that event might play out.
  • Urges: Though these intrusive thoughts feel like urges, they’re still unwanted. For example, maybe you don’t like your current position at work, so you have consistent urges to run out of the office, quit your job and move to a better location. Even though you have these urges, you would never do that because it would cause additional complications to your lifestyle and finances.

How to manage intrusive thoughts

When intrusive thoughts disrupt your day, the last thing you want to do is push them away. To explain this, Dr. Alexander uses an analogy of a bouncy ball.

“Imagine that you’re holding a little bouncy ball. If you throw it at the wall, what’s going to happen? It’s going to bounce off the wall, and it’s going to come back to you,” she illustrates. “If you throw the ball harder next time, it’s still going to bounce off the wall and come back to you. It doesn’t matter how hard you throw the ball, it’s always going to bounce off the wall and come back to you.”

Intrusive thoughts, then, are a lot like bouncy balls: They keep rebounding and bouncing around in your head even as you’re trying to push them away. And the more they interrupt your ability to think and function, the harder it becomes to move past them and let them go.

“Pushing intrusive thoughts away are never going to work,” Dr. Alexander continues. “Instead of relying on that strategy, there are other things you can do instead.”

Practice mindfulness and grounding techniques

When intrusive thoughts pop up and try to derail you, one of the simplest things you can do is to remember that anxiety is future-facing and ground yourself in reality around you. You can do this with grounding techniques like diaphragmatic breathing or the 5-4-3-2-1 exercise:

  • Find and focus on five things you can see.
  • Find and focus on four things you can touch.
  • Find and focus on three things you can hear.
  • Find and focus on two things you can smell.
  • Find and focus on one thing you can taste.

If you can’t interact with these things in your immediate surroundings, get up and actively search for them. Doing so will redirect your brain’s attention to the very real things around you so it doesn’t get stuck on the intrusive thought trying to gain ground.

“You can only smell, hear, touch, taste and see things that are happening in the present right now,” emphasizes Dr. Alexander. “Meditation and yoga are other great solutions — they’re not an active attempt to avoid thinking intrusive thoughts; they’re about focusing on the present and your senses.”


Try thought diffusion

This may seem counterproductive, but you’ll actually want to lean into those intrusive thoughts by acknowledging that they’re just thoughts, allowing them to arrive and then letting them go through thought diffusion.

“With thought diffusion, you take your thoughts and attach some visual imagery to them,” Dr. Alexander explains. “By approaching your thoughts from this perspective, you can have the thought and then set it aside.”

Maybe your thought comes to you on a cloud and then simply floats by you. Or you can imagine writing your thought into the sand just before a calm wave comes up and washes the thought away. And maybe sometimes, your thoughts are like lily pads on a stream, and they simply drift on the water in front of you and leave you behind.

“This meditative technique makes it easier for you to not get locked into these thoughts,” says Dr. Alexander. “We’re not pushing these thoughts away. We’re not getting rid of these thoughts. We’re letting these thoughts come and we’re letting them go without replaying them in our minds over and over while pushing them out.”

Get assistance with exposure therapy

As part of cognitive behavioral therapy, a therapist might guide you through a process called exposure therapy. This process occurs over several sessions, with each session gradually increasing your exposure or interaction with the things and ideas that trigger your anxiety, fear and experienced trauma. The idea is that over time, you learn to manage your anxiety symptoms and find helpful coping strategies. This approach to therapy is also helpful for dealing with intrusive thoughts.

Let’s say, whenever you’re getting ready to travel, you experience persistent, disturbing thoughts about your plane crashing. Exposure therapy, then, might begin with having discussions about your fears during the first session. In future sessions, you might look at pictures of planes or watch videos of planes in flight. Then, maybe you take a trip to the airport, all the while finding ways to confront your anxiety in real time.

“Exposure therapy is something that requires a skilled provider to guide someone through it,” notes Dr. Alexander. “The benefit is that exposure therapy can help extinguish the crippling anxiety people may experience.”

Are intrusive thoughts normal?

Believe it or not, intrusive thoughts are far more common than you might think. Everyone has them from time to time, it’s just that some intrusive thoughts land differently for some people and stick around a little longer than we’d like.

“You can’t change anything that’s happened that’s led up to the moment you’ve had this intrusive thought, but you can respond differently to it so that it doesn’t blow up into more of an issue than it actually is,” encourages Dr. Alexander.

“Think of how many thoughts you have in a day that you don’t get stuck on. If you have the capacity to do that with other thoughts, you certainly have the capacity to do that with any thoughts that pop into your head that you don’t want. It’s just a matter of using the right strategies to help you cope differently.”

When to seek help

It’s never too early or too late to ask for help when you feel like you need it. If you’re having violent thoughts, you’re concerned that you might act on those thoughts and you’re worried for the safety of others or your own safety, you should call 911 or your local emergency hotline and seek medical help right away.

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